You sit there trying to look casual and relaxed. If you happen to make eye contact with someone there is a very quick exchange of half smiles and then a quick look away. It is quiet. No one would ever dream of saying anything. People look at their cell phones or a magazine or straight ahead. A door opens and one of the therapists, still holding the door knob, looks at a patient, smiles and nods. Maybe the therapist says a first name. The patient gets up quickly as if embarrassed, then follows the therapist.
I make a point not to seem the slightest embarrassed, instead acting as if I’m in the green room of a talk show and have just been told I’m about to be announced. I stride eagerly behind the therapist anxious to unburden myself to this relative stranger, offering all manner of intimate detail about my youth or current state of affairs or anything in between. I sit very casually as if relaxing in front of the television set after a long day of work. I wait for my cue, which usually comes in the form of the question, “so how have you been?” Then I launch into whatever is foremost in my mind. I spew forth until I run out of momentum or until I’m interrupted with a question or a request for clarification.
If I’m seeing a therapist they will offer feedback, questions, or observations. If it is a psychiatrist there are liable to be silences. Long frustrating ones in which I can’t think of what to say or simply need a prompting. I’ve seen all kinds. Some seem to make a practice out of keeping their mouths closed. They regard you as if from afar, appearing to be passing judgment but not sharing it. This can be maddening. On more than one occasion I’ve barked at them, “well, say something!” I got up and walked out on one when I was a teenager. I passed him on the way to the door and he cowered -- evidently fearing that I was about to strike. However, some will talk. These are therapists who actually act concerned.
In most rooms there is the choice between a couch and a chair. I have never opted for the couch. There is a small table or a desk nearby with a handy box of kleenexes. Also accessible is a small trashcan and it often has used tissues in it. I suppose some have been utilized by people with colds or allergies but I further suspect that some patients cry. I’ve never cried. I may have gotten choked up once or twice and had to pause, but no one sees me cry other than my wife. I’m not proud of this, it just is.
There is always a clock clearly visible to the patient and another behind you that the therapist can see. It wouldn’t do for the doctor to be checking a watch or turning a head to find the time. I had one psychiatrist who yawned from time to time — always trying to stifle it and always apologizing for it — and he even left to pee a few times. None of the others have left their post.
For your first visit the therapist takes copious notes. Thereafter their hands are free. Sometimes folded in a lap, other times held in front of them as if in prayer. A psychiatrist will even stroke his chin. They may get a bit glassy-eyed but I’ve never noticed. Their eyes don’t stray. They look at you. I sometimes look straight back but my eyes tend to wander. To recall memories it sometimes necessary for me to tilt my head upwards to the left. When recounting a horror from my childhood I often look down. When talking about anxiety and especially when discussing a panic attack, I’ll fidget, change positions and occasionally work my way into an agitated state.
I love to make people laugh and have been doing since I was a small child and it is quite natural to me. So too during therapy sessions I’ll make quips even in discussing quite painful. Therapists almost never laugh, though sometimes you’ll get a chuckle and often a broad smile.
When your time is just about up (visits are always 50 minutes though you pay for an hour) your therapist will say, “our time is just about up,” and you’ll confirm or decide upon the time of your next appointment. Invariably they will get confused when looking at available times and it will turn out that Tuesday at 7:00 won’t work but there’s an opening Wednesday, how’s 7:30? Sometimes there's payment to discuss. This can be terribly awkward. With medical doctor's any talk about bills is done with someone in reception. To have to sort dollars and cents with the person with whom you have this completely opposite relationship with is weird and wrong. But that, as they say, is the way it is. I've never seen a shrink yet who had anyone else handle payment.
I always get up and say thanks and goodbye. I don’t know if this is par for the course. Once you’re standing the therapist seems anxious for you to leave as if you’re a guest who has long over stayed a visit. If you stupidly make idle chit chat about the weather or something else it is addressed perfunctorily, it is expected that you will be on your way. Once out the door you feel a bit refreshed maybe even rejuvenated. At the very least there is the sense that you’ve done yourself a good deed, that you are a healthier person for having shared the details of your being with another person. Sometimes you will ruminate over what was said and other times you will think of everything but what just transpired. You may or may not mentally re-visit the past 50 minutes later that day or the next. In any event your subconscious has a lot to mull over and ,as they say in AA, more will be revealed.
If anyone save a very trusted friend or immediate family member happens to ask where you’ve been you simply say, “an appointment" or "the doctor’s.” There is no longer a stigma about seeing someone for mental or emotional issues but you still don’t tell anyone that you of all people need any kind of such “help.” You’re fine, thanks. Actually you are fine because you are getting help. You’re taking care of yourself and that’s a good feeling.
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